Prasad Patki

Botulinum toxin‐type A in the treatment of drug‐resistant neurogenic detrusor overactivity secondary to traumatic spinal cord injury

In this section, many different issues are written about by authors from the UK, France, the Netherlands, the USA and Denmark, respectively. Topics covered are botulinum toxin in drug‐resistant neurogenic detrusor overactivity in spinal cord injury, dutasteride and BPH, the effect of childbirth on bothersome LUTS, female urethral strictures, and a new bulking agent in treating female stress urinary incontinence.

Effects of spinal cord injury on semen parameters.

Abstract Objective/Background: Neurogenic reproductive dysfunction in men with spinal cord injury (SCI) is common and the result of a combination of impotence, ejaculatory failure, and abnormal semen characteristics. It is well established that the semen quality of men with SCI is poor and that changes are seen as early as 2 weeks after injury. The distinguishing characters of poor quality are abnormal sperm motility and viability. In the majority of the men with SCI, the sperm count is not abnormal. We elaborate on the effects of the SCI on semen parameters that may contribute to poor motility and poor viability. Methods: Review. Design: PubMed and MEDLINE databases were searched using the following key words: spinal cord injuries, fertility, sexual dysfunction, and spermatogenesis. All literature was reviewed by the team of authors according to the various stages of sperm development and transport in the male reproductive cycle. Findings: The cause of asthenozoospermia appears to be multifactorial. Conclusion: Current literature does not support the preeminence of a single factor relating to neurogenic reproductive dysfunction in men with SCI. After SCI, there is ample evidence of disturbance of sperm production, maturation and storage, and transport due to an abnormal neuroendocrine milieu. Semen quality seems to be primarily affected by changes to the seminal plasma constituents, type of bladder management, and the neurogenic impairment to the ejaculatory function. Further focused and structured studies are required.

Dynamic biochemical information recovery in spontaneous human seminal fluid reactions via 1H NMR kinetic statistical total correlation spectroscopy.

Human seminal fluid (HSF) is a complex mixture of reacting glandular metabolite and protein secretions that provides critical support functions in fertilization. We have employed 600-MHz (1)H NMR spectroscopy to compare and contrast the temporal biochemical and biophysical changes in HSF from infertile men with spinal cord injury compared to age-matched controls. We have developed new approaches to data analysis and visualization to facilitate the interpretation of the results, including the first application of the recently published K-STOCSY concept to a biofluid, enhancing the extraction of information on biochemically related metabolites and assignment of resonances from the major seminal protein, semenogelin. Principal components analysis was also applied to evaluate the extent to which macromolecules influence the overall variation in the metabolic data set. The K-STOCSY concept was utilized further to determine the relationships between reaction rates and metabolite levels, revealing that choline, N-acetylglucosamine, and uridine are associated with higher peptidase activity. The novel approach adopted here has the potential to capture dynamic information in any complex mixture of reacting chemicals including other biofluids or cell extracts.

Lower urinary tract dysfunction in ambulatory patients with incomplete spinal cord injury.

PURPOSE We evaluated urinary tract dysfunction in individuals with spinal injury who remained able to ambulate. We observed changes with time in urological management. MATERIALS AND METHODS All patients attending outpatient clinics with traumatic, incomplete (American Spinal Injury Association grades D and E) spinal cord injury during a 2-year period were identified. All patients had their hospital notes reviewed retrospectively and salient urological data extracted. RESULTS A total of 43 men and 21 women were identified during this period. Mean age was 46 years (range 18 to 70). Mean followup was 7 years (range 1 to 18). At the time of inpatient discharge 40 of the 64 patients (62.5%) could void spontaneously, 20 required CSIC and 4 had a suprapubic catheter. In 19 of these 40 patients (47.5%) who had been initially assessed as having a bladder that was safe to void spontaneously the condition deteriorated, such that CSIC was required. Conversely 5 of 20 patients (25%) who initially required CSIC improved, such that it became redundant. At last followup 68.7% of the patients had abnormal urodynamics and 24 of the 64 (37.5%) required a change in urological management despite no appreciably detectable neurological change. CONCLUSIONS Despite relatively near total neurological recovery patients with incomplete SCI have neuropathic bladder unless proved otherwise. Salient deterioration in bladder dysfunction is not uncommon. Regular urological monitoring and appropriate treatment changes are required in the long term.

Patients’ perspective of botulinum toxin‐A as a long‐term treatment option for neurogenic detrusor overactivity secondary to spinal cord injury

To evaluate patients’ perspective on whether they would consider botulinum toxin‐A (BTX‐A) injections as a long‐term treatment option for managing their neurogenic detrusor overactivity (NDO) secondary to spinal cord injury (SCI).

PD60-09 ANALYSING 5-YEAR MEMOKATH OUTCOMES FOR MALIGNANT AND BENIGN URETERIC OBSTRUCTION: A PROPOSED UPDATE TO CLINICAL GUIDELINES

INTRODUCTION AND OBJECTIVES: Patient and disease characteristics influence ureteric stricture management with DJ stents, metallic stents, endoscopic, or reconstructive surgery. Memokaths are an option with reported 90-100% patency and 14-30% complication rates, but the published literature is limited by small sample size and short follow-up duration up to 22 months. Objective: To independently analyse 5-year Memokath stent outcomes, identifying variables associated with good outcomes to update clinical guidelines. METHODS: Management of obstructed ureteric stricture patients with Memokath stents was reviewed independently using electronic patient records. Outcomes included time to first complication, complications’ incidence and severity. Multiple linear regression was performed identifying variables linked with particular outcomes. RESULTS: 100 patients aged 23-87 years (mean 57) received Memokath stents for ureteric obstruction, 59% for malignant strictures, with 20% bilateral. Only 25 patients had no complications: either alive with, or dying of their primary malignancy with their original Memokath. Median time to complication in the remaining 75 patients was 12.5 months with Memokaths lasting longer in patients with malignancy (p1⁄40.02). Multiple linear regression analyses showed that increased eGFR (p1⁄40.005) and age (p1⁄40.0001) independently significantly predicted greater Memokath lifespan, while co-morbidities, stricture length and location, and underlying pathology, did not. 5 year outcomes: 25 patients had a Memokath in situ: 14 still alive with the original. 22 had other stents, while 12 required major surgery. 66% of patients with most severe complications (need for major surgery or dialysis) were in the benign group. CONCLUSIONS: Memokaths are a reasonable option for patients with malignant ureteric obstruction and life expectancy up to 1 year. Age and eGFR greater than 45 predicted longer Memokath duration. Patient and stricture variables other than aetiology did not affect Memokath durability, but should be considered for delivery of the most appropriate patient-centred individualised care. 5 year complication rates were significantly higher than previously reported (75 vs 25%). Updated practice guidelines would aid future patient selection and counselling, as well as encouraging protocolled follow-up and patient reported outcomes assessment, when considering metallic stent drainage for ureteric obstruction.

Long-term Results of Surgery for Stress Urinary Incontinence — A Urologist’s View

29.3 Treatment for Stress Urinary Incontinence . . . . . . . . 398 29.3.1 Surgery for Stress Incontinence . . . . . . . . . . . . . . 398 29.3.1.1 Outcome of Surgery for Stress Incontinence . . . . . . . 399 29.3.2 Open Colposuspension . . . . . . . . . . . . . . . . . . . 399 29.3.3 Laparoscopic Colposuspension . . . . . . . . . . . . . . 400 29.3.4 Endoscopic Bladder Neck Suspensions . . . . . . . . . . 400 29.3.5 Suburethral Slings . . . . . . . . . . . . . . . . . . . . . 400 29.3.6 Periurethral Injections . . . . . . . . . . . . . . . . . . . 400 29.3.7 Artificial Urinary Sphincter . . . . . . . . . . . . . . . . 401